Prevalence of bone marrow necrosis in Egyptian cancer patients referring to the National Cancer Institute

BackgroundBone marrow necrosis is a relatively rare entity which has been associated with a poor prognosis. It is most commonly found in patients with neoplastic disorders and severe infections.MethodsThe study comprised examination of 5043 bone marrow biopsy specimens performed at the National Cancer Institute, Cairo University, over 7 years period (March 2004–March 2011). It included 5 years retrospective (2867 archived samples) and 2 years prospective (2176 samples).ResultsBone marrow necrosis was diagnosed in fifteen out of 5043 examined specimens with a percentage of 0.3% and ranged from mild to massive according to semiquantitative estimation. Prognosis of all patients was poor with survival not exceeding 6 months from the date of marrow necrosis diagnosis.ConclusionIn Egyptian patients, bone marrow necrosis in association with malignancy is a rare disorder which is accompanied by a poor outcome.     

Multiresistant bacteria and current therapy - the economical side of the story

Severe infections with multiresistant bacteria (MRB) are a medical challenge and a financial burden for hospitals. The adequate antibiotic therapy is a key issue in multiresistant bacteria management. Several major cost drivers have been identified. Remarkably drug acquisition costs are not necessarily included. Most significant are the length of stay in hospital, the hours of mechanical ventilation and the time treated on an intensive care unit.In a systematic review of the literature the following aspects were investigated:- Do generic treatment strategies contribute in cost savings?- Are there specific results for recent antibiotics?Early adequate and effective antimicrobial treatment, switch from i.v. to oral therapy, adjusted duration of therapy and adherence to guidelines have been found to be successful strategies.Looking at specific antibiotics, the best evidence for cost-effectiveness is found for Linezolid in treatment of cSSTI as well as in HAP. Daptomycin shows good economic results in bloodstream infections, so possibly being a cost-effective alternative to vancomycin. Looking at tigecycline the published data show neither higher costs nor savings compared to imipeneme. Doripenem as one of the newest therapy options has proven to be highly cost-saving in HAP when compared with imipenem. However, most analyses are based on pharmacoeconomic modelling rather than on directly analysing trial data or real life clinical populations.

Conclusion

Using modern antibiotics in whole is not more expensive than using established therapies. Modern antibiotics are cost-effective and sometimes even cost-saving. This is especially true if an effective therapy is initiated as early as possible.     

Cryptogenic liver disease in HIV-seropositive men

Objectives In the era of highly active antiretroviral therapy (HAART), liver disease has become a leading cause of morbidity and mortality in HIV-seropositive individuals. Although liver disease is commonly caused by viral co-infection, it has also been described in patients without viral hepatitis. In this study, we determined clinical factors associated with the development of cryptogenic liver disease in HIV-infected individuals.
Methods HIV-seropositive and -seronegative patients undergoing evaluation for liver transplantation were selected if they met clinical criteria for cryptogenic liver disease. Clinical data were collected retrospectively, and radiological and histological data were reviewed separately.
Results Nine HIV-seropositive individuals were compared with 41 HIV-seronegative patients with cryptogenic liver disease. Only one HIV-seropositive patient (11%) had cirrhosis, compared to 39 HIV-seronegative patients (93%) ( P <0.001). Three HIV-infected patients (33%) had histological evidence of nodular regenerative hyperplasia. HIV-seropositive patients had significantly lower body mass indices, and lower Child–Pugh–Turcotte and Model for Endstage Liver Disease scores than HIV-seronegative patients ( P <0.05).
Conclusions Advanced cryptogenic liver disease in HIV-infected patients is infrequently caused by cirrhosis, and more frequently by nodular regenerative hyperplasia. This disease entity may become more common in the HAART era, and may contribute to an increased morbidity in HIV-infected individuals.     

A light-guidance system to be used for CT-guided biopsy

We describe a light-guidance system that uses intersecting helium-neon laser beams to provide precise guidance for biopsy approaches from any direction (including compound angles) during CT-guided biopsy of the chest and abdomen. Interactive software provides visualization of the proposed path, indicates the segment of that path that will pass through each section, and displays the settings for the apparatus.     

Measurement of renin in segmental renal veins of hypertensives

In 27 of 270 patients studies for possible renovascular hypertension, a lesion affecting a segmental renal artery was seen on angiography. In 22 patients who had sufficient data, the significance of measuring segmental-renal-vein renin in the diagnosis and treatment of segmental disease was evaluated. In 11 (50%), the renin values of segmental vessels supported the clinical diagnosis. In four (36%) of these 11, a high-renin-release area would not have been identified without the stress of upright posture. Successful treatment of hypertension was achieved in six of nine patients who had a revascularization procedure or resection of the segmental vessels. Samples from involved and uninvolved segments of the kidney as well as from the contralateral renal vein and inferior vena cava, together with the stimuli of sodium and volume depletion augmented by upright posture, enabled confirmation of the angiographic diagnosis of segmental-renovascular hypertension.